An ingrown toenail is a common form of nail disease. It is an often painful condition in which the nail grows so that it cuts into the side of a nail fold. While ingrown nails can occur in both the nails of the hand and feet, they occur most frequently with the toenails. A true ingrown toenail is caused by the actual penetration of the flesh by a sliver of a nail.
The most common cause of an ingrown toenail is cutting one's toenail too short. Other causes of an ingrown toenail can be from wearing socks and shoes that are tight or short, a fungal infection and trauma, for example from stubbing your toe or having an object fall on an individual's toenail.
Symptoms of an ingrown nail can include, without limitation, pain, redness and swelling of the toe or infection. Pain can occur along the margins of the nail with the pain worsening when wearing tight footwear and sensitivity to pressure of any kind. Bumping an affected toe can produce sharp, even excruciating pain as the tissue is punctured further by the nail. By the very nature of the condition, ingrown nails become easily infected unless special care is taken to treat the condition early on and keep the area clean. Signs of infection include redness and swelling of the area around the nail, drainage of fluid and watery discharge tinged with blood or purulent discharge.
Ingrown toenails that are left untreated can eventually lead to osteomyelitis, which is an infection in the bone. This serious infection can be especially severe for individuals with diabetes or circulatory problems in their lower extremities.
Treatment of ingrown toenails depends upon the severity of the condition. A podiatrist may recommend a simple treatment such as soaking one's foot in Epsom salts or in an antibacterial solution. Treatment may also include trimming of the ingrown toenail. However, in many instances, these are only temporary solutions as ingrown toenails tend to reoccur and become chronic.
A more permanent treatment option is to perform what is known as a P & A (phenol and alcohol) or partial matrixectomy procedure. This procedure eliminates the nail matrix, which is located behind and underneath the cuticle where the ingrown toenail grows to ensure that the nail does not grow back where the matrix has been cauterized/ablated so the chances of further ingrowths are substantially reduced. Occasionally, the ingrown nail can reoccur which would then require the procedure to be performed again.
Typically, in a P & A procedure, a podiatrist first injects a local anesthetic into an appendage (e.g., finger, toe) to numb it. The podiatrist next applies a tourniquet to prevent bleeding while the procedure is being performed. The ingrown nail is then removed. The amount of nail that is removed is approximately two to three millimeters or slightly more. In order to remove the nail matrix, a strong acid such as phenol is used in the procedure.
Specifically, in a P & A procedure a cotton tip applicator is saturated with phenol, which is a very strong acid solution. The applicator is then inserted under the skin until it comes into contact with the nail matrix. The applicator is then continuously rotated on the matrix for approximately thirty seconds. The treatment typically comprises a total of three applications for a combined total of approximately ninety seconds. This procedure destroys the matrix area in order to permanently and selectively ablate the matrix that is manufacturing the ingrown portion of the nail (i.e., the nail margin). The surgical site is then irrigated with alcohol to flush out the remaining phenol. A topical antibacterial ointment or cream may thereafter be applied followed by the application of a dry sterile dressing. The tourniquet is then removed.
However, in the above-described surgical procedure, a phenol solution usually comes into contact with the skin and nail bed, which regularly causes burning and damage to these soft tissue structures, producing post-operative pain, prolonging the healing at the surgical site and, in some instances, leading to post-operative infection. Eliminating and/or reducing the contact of phenol with the skin and/or nail bed would aid in reducing burning, post-operative pain and the time required for healing of the surgical site.